Project Access Now - Annual Report - 2019

2018-19 ANNUAL REPORT Project Access NOW (PANOW) is dedicated to improving the health and well-being of our communities by ensuring access to care, services and resources for those most in need.

THE CHALLENGE Too many people face barriers to getting what they need to be healthy. Factors like income, immigration status, housing, languages spoken, and more can make accessing life-saving care and resources difficult to impossible for some people in our community. These community members need help and they need it NOW.

OUR SOLUTION PANOW is a community solution. We partner with health systems, government, and community organizations to reduce the obstacles people face when accessing care and services. We develop programs and strategies to help those most in need overcome those obstacles.

Everything we do is in collaboration. We work in partnership with other entities and efforts, making the most of existing resources and promoting systematic solutions. We promote better alignment, efficiency, and effectiveness for our clients and partners.

OUR VISION Our vision is a healthy community with consistent access to care, services, and resources. The path to this vision is complex, and sometimes slow and arduous. The health care landscape has greatly evolved since our inception - and PANOW alongside it. We strive to remain grounded in the day-to-day realities of the people we serve. We look forward to the collaborative work ahead as we continue to improve the health of our community.

Page Two

OUR VALUES DIVERSITY, EQUITY, & INCLUSION We honor the fundamental value and dignity of all who we work with and serve.

We strive to create an environment that respects and includes diverse perspectives, traditions, and experiences. We commit to furthering equity throughout our organization.

CELEBRATION Our success depends on the contributions of each team member. We honor and care for one another as a community and celebrate our individual and collective accomplishments.

FLEXIBILITY & RESILIENCE We are adaptive and resilient as we encounter changing circumstances. We seek and embrace new ideas with enthusiasm and draw on the strength of our diversity for solutions that are enterprising and dynamic.

TRANSPARENCY IN LEADERSHIP We listen with intention to understand, providing timely and open communication about organizational decisions. We are building an inclusive organization in which leadership actively seeks staff engagement and input.

CREATIVITY & INNOVATION As a growing organization, we nurture an environment where creativity, persistence, risk-taking, patience, caring, and the desire to contribute are encouraged and embraced.

Testimonial “I came to Project Access NOW overwhelmed and in tears. I was six months pregnant and had not yet been able to access prenatal care.

Project Access NOW helped me access care, and I saw a doctor right away.”

- PANOW Participant

Page Three

A YEAR OF CHANGES & CHALLENGES Last year, Project Access NOW faced unprecedented changes and challenges in the regional health care landscape. The families we serve are often negatively affected by these changes. Fortunately, Project Access NOW and our partners were able to support those most in need again during our fiscal year 2018-2019, which ended on June 30th of 2019. I present this report as an accounting of our activities and impact over the last year.

Immigration The ongoing national debate around immigration has negatively affected how immigrant communities in Oregon access care and social services. The federal anti-immigrant rhetoric and policies, from Immigration Linda Nilsen, Customs and Enforcement raids to public charge Former Executive Director modifications, have stoked fear among many of the communities we serve. As often happens when people are in fear, our clients often opted out of needed health care and services.

In partnership with allied health care organizations, we have continued to provide care and services to a population already marginalized and experiencing health inequities.

Misinformation and fear are powerful threats to this work, and we continue to combat this and assure equal access to care regardless of a person’s race, ethnicity, immigration status, or other identity.

Medicaid Expansion and CCO 2.0 Oregon has led the country in transformational change through our creation of Coordinated Care Organizations (CCO). This system ensures Medicaid funding is used in the context of actually creating health and using public resources in ways that incentivize health care (as opposed to sick care). Medicaid expansion has been an incredible benefit for tens of thousands of low-income Oregonians. However, it has so far been limited in its scope and has not yet improved the situation for many Oregonians who remain uninsured. Those who continue to be left out of this system actually face more barriers than before, for a variety of reasons.

As a state, we are moving into the next iteration of CCO contracts (referred to as CCO 2.0). This change emphasizes addressing social needs to impact larger, systemic factors known as the social determinants of health. There is a growing recognition that, in order to improve community health, we must not simply provide access to health care. Instead, we must make sure the basic needs of all are fulfilled. We are building connections with CCOs in order to support community health beyond just Medicaid members. Where appropriate, we are also sharing infrastructure to assure uninsured individuals have access to many of the same resources as Medicaid-insured patients.

Page Four

A YEAR OF CHANGES & CHALLENGES (CONT.) Bridging Gaps Even with Medicaid Expansion, CCOs, and other resources, gaps persist in the ability to get health insurance and access health care. Project Access NOW programs are all about filling and bridging gaps. From helping people get enrolled in a health insurance plan (if they qualify), to helping pay premiums for low-income people (who make just a little too much money to qualify for other supports), to facilitating access to donated care and low-cost pharmaceuticals, Project Access NOW supports those most in need. Project Access NOW is both responsive to change – both good and bad - as well as proactive in identifying ways to improve systems that create and perpetuate health disparities in our community.

Linda Nilsen, PANOW Founder & Former Executive Director

Testimonial “Project Access NOW helped me call a hospital to address a bill that had been sent to claims. I couldn’t understand the bill and wasn’t sure why this had happened. When the PANOW staff person called, they said it was a mistake due to a misspelled name. It helped to have an ally to help solve this stressful situation.” - PANOW Participant

Page Five

PROGRAM ACCOMPLISHMENTS: 2018-19 YEAR

Classic Care Coordination PANOW works with safety net clinics, all area hospital systems, and most of the major specialty and multi-specialty clinics in metropolitan Portland to provide donated care to those who remain uninsured and meet specific income guidelines. The majority are immigrants - documented and undocumented - who are unable to receive health insurance coverage under the Affordable Care Act or Medicaid expansion.

9,276 Clients Served

$2.5M

Received by Clients (Goods or Services)

20,248 Requests for Services

4,511

Referrals Issued

4,335

Appointments Made

61% Increase 8,254

People Served 5,126

$16.5M

In Services Provided

Community Assistance Program (C3CAP) When individuals with low-income, or other barriers to equitable care, are discharged from a hospital stay or emergency room visit, they face additional barriers to recovery. With C3CAP, we support discharge planners, social workers, and care managers to connect low-income patients to the resources they need for safe discharge. These resources may include transportation, temporary housing, and medication assistance.

Testimonial “I was having extreme difficulty getting dental care. The clinic I was using seemed to never pick up the phone and I wasn't sure who to call.

I came to PANOW extremely frustrated at the fractured system. Project Access Now helped me call my insurance provider and find a new dentist available in my area.” - PANOW Participant Page Six

PROGRAM ACCOMPLISHMENTS: 2018-19 YEAR Testimonial “My family arrived from Guatemala only one month ago and did not know how to access health care in Oregon. After we went to our son’s school for help with a serious toothache, they helped connect us to staff from Project Access NOW, who visited us at home. They helped make sure we had an appointment with a dentist and found us transportation as well. Without their help, I’m not sure what we would have done.” PANOW Participant

Outreach, Enrollment and Access Our team of certified application assisters helps families enroll in the Oregon Health Plan (OHP) and Qualified Health Plans (QHP) with a special focus on individuals with low-incomes, who may not realize they qualify for health insurance or face barriers to enrolling. Since 2015, our staff has helped more than 70,000 individuals enroll in health insurance. To ensure individuals are able to turn coverage into access, we offer health literacy and navigation services.

Bilingualism (Spanish-English) is a key component of this program.

16,132

Individuals Enrolled in Health Coverage

7,527

Instances of Navigation Assistance Services

$1,209,442

Spent on Premium Assistance 19% Increase over last year

827

People Served

Premium Assistance This program pays health insurance premiums for clients who earn too much money to qualify for Oregon Health Plan, but too little to afford premiums and out-of-pocket costs. PANOW leverages tax credits to offset premium costs and pays the remaining balance. Clients receive help paying their pharmacy co-pays and deductibles, and other co-pays are reduced or eliminated when possible.

Page Seven

PROGRAM ACCOMPLISHMENTS: 2018-19 YEAR

Pharmacy Bridge Pharmacy Bridge offers low- or no- cost medications to uninsured or underinsured clients that a provider has determined they need to be healthy. Pharmacy Bridge is a Pharmacy Benefit Management product that allows for clients to use any pharmacy across the state that accepts Providence Health Plan, which is the administrative benefactor of the program. Clients receive their medications for no more than $4.00.

16,816

133% Increase

Prescriptions Filled 2017-18

$1,422,645 Total Savings Among Those Served

288% Increase 2018-19

177

Families Connected with Services

Community Partnerships We work with key health care systems in Oregon to implement our programs and reach those most in need. Additionally during the annual enrollment period, to 16% Increase over raise awareness around healthcare issues, last year and through other initiatives - PANOW partners to get the word out. Past and current regional partners (in Hillsboro, Canby, Portland, Newberg, Sheridan, Aloha, and more), include: Oregon Health Insurance Marketplace, Oregon Department of Human Services, Gladstone Center for Children and Families, Canby Neighborhood Health Center, The Rosewood Initiative, Sheridan Public Library, Familias en Acción, El Programa Hispano Católico, Portland Opportunities Industrialization Center, Impact NW, Volunteers of America, Northwest Family Services, IRCO Asian Family Center, Latino Network, and many more.

Page Eight

CLIENT STORY: NEPTALINA LEMUS “We left Guatemala with a great pain in our hearts. Our family was there, but we decided to come here because our country is very poor. There’s not much of a future there. Our children are the reason we came to Oregon. My son plays soccer, and he hurt his knee. There was a volunteer from Project Access NOW, and she told us about the program. Project Access NOW was a light in the dark, helping us figure out what to do. Eventually, they helped my husband and me as well.

I’ve endured pain rather than go to the hospital because I didn’t know how much I would be charged. I’d stand the pain rather than live with the fear of not having insurance or not knowing how I was going to pay for it. [Working with Project Access NOW] was calming because we knew weren’t alone. We knew that someone was there to help us. Finding this program was like a blessing to us. They’ve helped us a lot, and they’ve never let us down. It’s been sixteen years and still [they help us] to this day. The most important thing to me is family and to be healthy.

[I want to be here to] have grandkids.”

PROVIDER STORY: EHUD ZUSMAN, MD Dr. Zusman has only been donating urology care through PANOW for a year, but he knows the value of his work for those in need and finds it rewarding. “I feel that being able to access health care is something everyone should have,” he says. “I feel fortunate [The Portland Clinic] is taking part in the collaboration with Project Access NOW and allowing doctors to take part.” Hailing from Israel, Dr. Zusman immigrated to the U.S. at 22 with his wife, and got his first job stateside as a maintenance worker.

“For many years I was too poor to afford health care,” he says. Following his medical school studies at Temple University and a residency, he moved to Oregon where he joined The Portland Clinic in 2002. His experience of poverty and lack of health access informs Dr. Zusman’s work with Project Access NOW clients.

“My history is something I share with PANOW clients,” he says. Most patients he sees are immigrants of limited means. “So when a colleague told me the Clinic would join the program, I was happy to sign on as well.” The Portland Clinic’s urology practice has been our partner in donated care since early 2018. In addition to Dr. Zusman, urologist Jeffrey Woldrich, MD, also treats Project Access NOW patients. The urology specialty is a very limited resource in the community, so this gift of services allows for shorter wait times for the most urgent cases.

Dr. Zusman says, “It’s socially responsible for us as physicians to try to get as many people as possible the care they need.” He adds, PANOW patients are appreciative. “One of the patients felt I wasn’t compensated enough,” he says, “so she drew me a picture, which I cherish.”

Page Nine

PROJECT ACCESS NOW GALA: FRENCH BISTRO Saturday, April 13 2019 We had a wonderful time at this year’s Project Access NOW Gala: French Bistro connecting with our community partners, supporters, and friends. It was both amazing and humbling to feel the energy and see the diversity of partners and people in the room.

The point of the gala is not only to celebrate our accomplishments together but, most importantly, to raise much-needed funds for our mission. The paddle raise and the auction raised significantly more than last year. The ticket sales and contributions support our clients.

Our work is all about the people we are honored and privileged to serve. Thank you for making it possible.

A shoutout to our event committee volunteers who outdo themselves every year putting on the annual gala. We could not have done this without them. And thanks to our board, staff, volunteers, and speakers who made this event such a success.

A Special Thank You Our work entails radical collaboration. We need to work together, and together we have the heart, drive, and commitment to make health and well-being equitable and sustainable for everyone. A very special thanks to our five incredible co-presenting sponsors:

Page Ten

BEHIND THE 2018-19 FIGURES Accrual-based accounting can often make it challenging to grasp an organization’s financial status at a glance. While our financials indicate a $640,000 accrual deficit, our cash position was solid. All payments were made on time and we ended the year with all accounts in good standing.

As happens with accrual-based accounting, we had several situations in which revenue was recognized in the previous year but expenses were not incurred until this year. One example of this was a $1,000,000 donation we received for our Community Assistance Program to pay for supportive services for clients being discharged from the hospital. This donation was received in 2018, and therefore noted as revenue that year, yet it was meant to span two subsequent full fiscal years during which expenses would be incurred.

We have an excellent Finance Committee who reviews our financial statements on a monthly basis. Between our accrual accounting reports, cash-based reports, and a financial dashboard with key performance indicators, we are equipped to manage the challenges of managing cash flow in the short and long term, as well as the overall financial health of the organization.

We also recently welcomed Marianne Baca as PANOW’s Director of Finance and Operations.

Baca is a CPA with many years of auditing financial statements and managing the complex financial health of several nonprofits. She was the Treasurer of PANOW’s Board of Directors before joining as staff this past summer. We are very fortunate to have Marianne’s skills and energy supporting our organization’s financial health and stability.

Page Eleven

FINANCIALS

2017-18 REVENUE $7,044,984

2018-19 REVENUE $6,678,711

In-kind contributions Contract revenue

Individual contributions

Events

Contract revenue

Other income

Individual contributions 13.4%

Events

Other income

7.2%

Foundation grants

Foundation grants

88.9% 84.8%

2017-18 EXPENSES $6,682,995 Management and administration

Program services

2018-19 EXPENSES $7,039,691 Management and administration

Fundraising

Fundraising

Program services

Page Twelve

THANK YOU Most importantly, we are where we are thanks to our continued engagement with individuals and partners in our community. In truth, collaboration is the foundation of Project Access NOW and all of our accomplishments are the result of many partners and supporters. No one does this important work alone.

Sponsors & Partners Adobe Adventist Health Atlassian Cambia CareOregon Google Health Plans of Oregon Intuit Kaiser Permanente Last Pass Leap Test Legacy Health Mill Plain Medical and Pharmacy

Mobile Beacon Nurse Practitioners of Oregon Oregon Health and Science University Providence Oregon Stoel Rives Tech Soup The Howells Group The Oregon Clinic Think Real Estate Tuality Healthcare United Way of Columbia-Willamette VM Ware

Individual Donors Birkey, Carly Jean Charboneau, Thursday Cox, Monica De La Harpe, Jackleen Fair-Taylor, Erin Fletcher, Cindy Frey, Todd Garrison, Bud Hamilton, Martin Hart, Robert Hatfield, Susan M. and Robert S., Jr. Hecht, Ann Hicks, Graham and Barbara Johnson, Dave

Kellar Fox, Judy Kern, Michael Korchnak/Sauve, Peter and Lindsay Lashley, Pilar Leslie, Virginia (Jennie) Martin-Campbell, Sunny Oftedal, Kathryn and Terry Pacheco De Paez, Sofia Perry, Ellen Pew, Britt and Chris Smith, Matthew and Lisa Stoltenberg, Susan Taxer, David Watters, Amanda

Page Thirteen

2018-19 BOARD OF DIRECTORS Tim Hatfield, Chair | Stoel Rives LLP Joseph Ichter, Treasurer | Providence Health and Services Adrienne Buesa | Oregon Health and Science University Bud Garrison | Oregon Health and Science University Carly Hood-Ronick | Oregon Primary Care Association David Fuks | Fuks Consulting Dianne Danowski-Smith | Publix Northwest Public Relations Erin Fair-Taylor | Care Oregon Jefferson Mildenberger | Kaiser Permanente Jennie Leslie, MD | Virginia Garcia Memorial Health Center Lauren Foote Christensen | Legacy Health Michael Donchi | Point B Pam Mariea-Nason | Providence Health and Services

2018-19 STAFF Linda Nilsen | Founder and Executive Director Janet Hamilton | Deputy Director Marianne Baca | Director of Finance and Operations Sheila Hale | Senior Program Manager Jennifer Gonnella | Classic Program Manager Stephanie Marson | C3 Community Assistance Program Manager Linzay Shirahama | Premium Assistance Program Manager Katia Ariceaga | Outreach, Enrollment and Access Supervisor Ellie Solares-Solis | Outreach, Enrollment and Access Supervisor Kari Lyons | Regional Community Health Network Senior Project Manager Patrick Nelson | Information Technology Program Manager Shannon Kelley | Office Administrator Sylvia Ní hIvers | Executive Assistant

Page Fourteen

OUR IMPACT CONTINUED

Testimonial “When I was diagnosed with cancer, I was worried that I could lose my medical coverage. I went to Project Access NOW overwhelmed by worry, not being able to focus on getting better due to worrying about the future. They helped me determine that me and my daughter could continue to have medical coverage. Now I can focus on my health!” - PANOW Participant

Testimonial “I came to Project Access NOW worried because my children had had no health insurance coverage for over a year. I had tried to fill out applications online, but felt overwhelmed by how complicated the system was. The staff were so kind and helped me fill out the paperwork. I have peace of mind knowing my children have coverage now.” - PANOW Participant

Page Fifteen

Project Access NOW P.O. Box 10953 Portland, OR 97296 (503) 345-6553 www.projectaccessnow.org Facebook.com/PANOWPDX Twitter.com/PANOWPDX

Copyright © 2018 Project Access NOW